Will there be a PA and NP turf war?

[tmac12]

Will there be a huge turf war between pa and NP? In the future there will be more supply then demand. On US Bureau of labor both of these professions are projected to have a huge growth. Everyone will be competing for similar jobs it seems. How do you see things will play out in the future? will you see PA being the provider of choice or NP being the provider of choice all competing for same jobs? If I was a doctor that is in charge of hiring it seems more advantageous to hire a PA while if I was a hospital/manager or not a doctor it would be better to hire a NP. What are your thoughts?

[ApolloPA]

 

14 minutes ago, tmac12 said:

Will there be a huge turf war between pa and NP? In the future there will be more supply then demand. On US Bureau of labor both of these professions are projected to have a huge growth. Everyone will be competing for similar jobs it seems. How do you see things will play out in the future? will you see PA being the provider of choice or NP being the provider of choice all competing for same jobs? If I was a doctor that is in charge of hiring it seems more advantageous to hire a PA while if I was a hospital/manager or not a doctor it would be better to hire a NP. What are your thoughts?

Idk but hopefully it doesn’t mean compensation goes down.

[mgriffiths]

From individual physicians that I have spoken with, most seem to prefer PAs - not just because of education differences but because of their push for autonomy/equal standing.  But, that is a pretty small sample size.

I could definitely see how hospitals would potentially prefer NPs because nurses have many of the manager positions and in the states that NPs have won independent practice they don't require oversight which also makes the hiring process easier.

Bottom line, we have catching up to do because the privileges provided to NPs are never going to roll back.  I'm not a supporter of PA independence, except for very specific instances with limitations - but I unfortunately do believe that this is the track we must push toward because of the NP lobby.

Honestly, I would prefer just to make a bigger cut of the pie.  I can't complain too much, I make a good salary and I am in a good job, but I know what the docs make in my practice and all of them work less clinic hours than I do.  In fact the majority of their income isn't even from seeing patients, it's the "non-productivity" kickbacks that the insurance companies send for us meeting specific requirements (overheard 3 of the docs talking last month about how they were receiving a kickback of ~$40k EACH from insurance companies - and a lot of that is based on my work - and they receive these multiple times per year!).  Why should I make less than 1/3rd the income of the docs? I know I didn't go to medical school, I didn't pay forward the money to buy into the practice (an option not available to me), but when I do almost the exact same job I should make a bit more than 1/3rd.

[tmac12]

19 minutes ago, mgriffiths said:

From individual physicians that I have spoken with, most seem to prefer PAs - not just because of education differences but because of their push for autonomy/equal standing.  But, that is a pretty small sample size.

I could definitely see how hospitals would potentially prefer NPs because nurses have many of the manager positions and in the states that NPs have won independent practice they don't require oversight which also makes the hiring process easier.

Bottom line, we have catching up to do because the privileges provided to NPs are never going to roll back.  I'm not a supporter of PA independence, except for very specific instances with limitations - but I unfortunately do believe that this is the track we must push toward because of the NP lobby.

Honestly, I would prefer just to make a bigger cut of the pie.  I can't complain too much, I make a good salary and I am in a good job, but I know what the docs make in my practice and all of them work less clinic hours than I do.  In fact the majority of their income isn't even from seeing patients, it's the "non-productivity" kickbacks that the insurance companies send for us meeting specific requirements (overheard 3 of the docs talking last month about how they were receiving a kickback of ~$40k EACH from insurance companies - and a lot of that is based on my work - and they receive these multiple times per year!).  Why should I make less than 1/3rd the income of the docs? I know I didn't go to medical school, I didn't pay forward the money to buy into the practice (an option not available to me), but when I do almost the exact same job I should make a bit more than 1/3rd.

I agree 1/3rd seems pretty low. What do you think would be fair compensation?

[mgriffiths]

I would say somewhere in the ballpark of 2/3 to 3/4 - but this is for primary care in a clinic setting.  Why should my collaborating physician make >$50,000 on my work (and that is just from patient visits)?  The physician replies with, "I'm taking the majority of the risk because I'm the one who will get sued if there is a problem and I review your charts!" I've watched my CP review my charts, it is about 5 seconds per chart (or as long as it takes for the EMR to load the button so he can move to the next). The claim regarding malpractice is mostly true, and is the problem with the requirements right now with collaborating physicians - they can get sued without ever seeing the patient - in my opinion that's wrong.  The PA/NP who made the error is much less likely to be sued putting the brunt of the risk on the physician, but this is changing somewhat.

For specialties it would be different because the job description can be so different.  I know PAs who work in ortho and do the majority of the prepwork getting patients sized for joint replacements, seeing patients in clinic, assisting in surgery etc.  I also know others who only see patients in clinic or only assist in surgery.  Those job descriptions are vastly different and in my opinion would require very different salaries.

[EMEDPA]

8 hours ago, tmac12 said:

I agree 1/3rd seems pretty low. What do you think would be fair compensation?

as an experienced PA, minimum 50% of the doc rate in any given specialty. as a new grad, 1/3 sounds about right in specialties and closer to 50% in primary care.

As an experienced em pa, I make just a few bucks/hr less than fp docs who are scheduled opposite me in a rural ER and 1/2 what the residency trained/boarded em guys make. and I am ok with that.

PS: there already is a pa/np turf war. In most places it lands like this:

PA: em, surgery, ortho, trauma

NP: primary care, psych, women's health, peds, NICU

everything else is up for grabs.

[lkth487]

For NICU/Peds, honestly, these days it's just based on availability.  Most places are hiring anyone who wants to do the job, even in a place like NICU where you have a specialized NP degree (NNP).

[CorpsmanUP]

37 minutes ago, lkth487 said:

For NICU/Peds, honestly, these days it's just based on availability.  Most places are hiring anyone who wants to do the job, even in a place like NICU where you have a specialized NP degree (NNP).

I agree with this. There is a reason 5 PA post grad residencies in neonatology have started in the past three years. There is a huge demand and need. In part to the change in peds residency requirements three years ago, and also many peds fellowships only fill half their spots each year. Peds is hurting for bodies.

I have multiple offers/contacts every month all over the US, and every one of them is for more than $100+ an hour

[boli]

45 minutes ago, lkth487 said:

For NICU/Peds, honestly, these days it's just based on availability.  Most places are hiring anyone who wants to do the job, even in a place like NICU where you have a specialized NP degree (NNP).

Why would you say there's such a demand in peds? Compensation? Working with kids is hard? 

[surgblumm]

Let's remember that the time for turf wars is really over as many have decided that when looking at similarities and differences that we are paternal twins. I can think of all the excellent PAs that I have worked with and taught over the past 46 years and am proud of our profession. I have also worked with and taught NPs for about fifteen years and their capacity to learn is extremely high, they are excellent clinicians and are Aces in prevention. Most hospitals that I know have NPs in this area and it is a place that PAs need o prove themselves and when getting there need to shine and to become part of the education and PR force.

[lkth487]

7 hours ago, boli said:

Why would you say there's such a demand in peds? Compensation? Working with kids is hard? 

All of the above. For physicians, you take a significant pay cut if you work with kids. You can expect to make anywhere from 1/3 to 2/3 of your adult colleagues in most specialties.  Even the best paid pedi specialty (neonatology) didn't fill this year.  But hey, we are way more satisfied with our career according to every survey!

Also the job market for the attendings in pedi specialties is rough, depending on the specialty - there are virtually zero pediatric cardiology jobs for example, even coming from the top programs, especially in interventional or EP.  Interventional cardiology in pediatrics is one of the coolest things ever - going in and closing a congenital lesion in a newborn baby has been the coolest thing I've done in my training.  But I would never do it as a specialty because there's literally less than 3 jobs that open up per YEAR.  Pedi heme/onc is also cool, especially BMT, but again the job market isn't great and the jobs come with a significant research requirement.  So if you're not externally funded, it's hard.

But less attending physicians means there's always more jobs for the APPs and every place is hiring, usually in multiple departments.

I don't think the PA/NPs are underpaid in peds compared to adults, as far as I know.   Obviously you have to compare them to adult medicine specialties, rather than the surgical ones. 

[HMtoPA]

Remember that, for many jobs, we're completely interchangeable. Sure, you will see listings that specify one or the other, but I feel like I see at least an equal number of wants ads for "PA/NP" as for one or the other.

I've seen the term APC (Advanced Practice Clinician) thrown around a lot more lately, maybe it's a regional thing (WA), but it's a way to lump us together since we can fulfill the same role.

To be honest, most of the time that I've seen a job listing specify one or the other, it usually seems to skew NP. Again, it may vary regionally (and by specialty).

[Cideous]

Already happening.  Come to DFW and see the feeding frenzy going on between PA's and NP's.  

[tmac12]

7 hours ago, Cideous said:

Already happening.  Come to DFW and see the feeding frenzy going on between PA's and NP's.  

What is dfw

[EMEDPA]

18 minutes ago, tmac12 said:

What is dfw

dalls/ft worth texas

[sas5814]

If our current and future leadership has a brain in their collective heads we will push past the "us vs them" mentality and start working collaboratively on the political and regulatory level. It is past due.

I think we are beginning to see market adjustments as more and more providers are available and more and more are starting to do more work for less pay. It will trend this way for a while because bean counters are making all the decisions these days and quality of care is a distant second to money. Eventually that trend will correct as well but it won't be in my professional lifetime.

[Guest Paula]

The NPs who agree to work with PAs on the regulatory and political level will advocate for themselves to regulate and supervise the PAs.  That way, since the NPs are doctorate trained they will be positioned to take over the supervisory role that physicians once had.  The physicians will love it.  NPs will make "supervisory" fees and will want all PAs to learn the way of a nurse brain.

Then we will all eat our young together. 

 

[delco714]

The NPs who agree to work with PAs on the regulatory and political level will advocate for themselves to regulate and supervise the PAs.  That way, since the NPs are doctorate trained they will be positioned to take over the supervisory role that physicians once had.  The physicians will love it.  NPs will make "supervisory" fees and will want all PAs to learn the way of a nurse brain.
Then we will all eat our young together. 
 

This is the worst thing I've ever read.. Paula you can't say that knowing how much closer to retirement you are than the likes of I!

[JDayBFL]

On 3/16/2018 at 2:42 AM, CorpsmanUP said:

I agree with this. There is a reason 5 PA post grad residencies in neonatology have started in the past three years. There is a huge demand and need. In part to the change in peds residency requirements three years ago, and also many peds fellowships only fill half their spots each year. Peds is hurting for bodies.

I have multiple offers/contacts every month all over the US, and every one of them is for more than $100+ an hour

I agree, peds and especially peds surgery and neonatology are seeing the value of PAs.

Example: Texas Children's Hospital in Houston, TX (largest children's hospital in nation) they have >100 APPs in surgical departments alone and probably 80-90% are PAs. (Source: did PA Surgery fellowship there) 

do a job search on Indeed of Pediatric PA surgical positions-- between clinic, inpatient, and OR positions there are several hundred across the nation. After finishing my fellowship I had my pick of positions across the nation at top peds hospitals: Boston, Texas Children's, CHOP, Seattle children's, Nationwide, Stanford (Packard children's), etc. The jobs are there and awaiting PAs because NPs don't have the scope for outpatient/inpatient/OR that we have. 

[Cideous]

8 hours ago, JDayBFL said:

I agree, peds and especially peds surgery and neonatology are seeing the value of PAs.

Example: Texas Children's Hospital in Houston, TX (largest children's hospital in nation) they have >100 APPs in surgical departments alone and probably 80-90% are PAs. (Source: did PA Surgery fellowship there) 

do a job search on Indeed of Pediatric PA surgical positions-- between clinic, inpatient, and OR positions there are several hundred across the nation. After finishing my fellowship I had my pick of positions across the nation at top peds hospitals: Boston, Texas Children's, CHOP, Seattle children's, Nationwide, Stanford (Packard children's), etc. The jobs are there and awaiting PAs because NPs don't have the scope for outpatient/inpatient/OR that we have. 

 

I think this post is important for PA's in school or those just out.  The moral of the story is...Do a residency.  The days of just being trained by your doc are rapidly fading.  If I could give one piece of advice to young PA's, that would be it.  Do a residency.

[Gordon, PA-C]

Peds is struggling because the peds subspecialists in many cases make LESS than the peds primary care doctors do.

Take cardiology or heme/onc for example.  75% of those patients are on Medicaid.  That means you get a massive paycut compared to adult specialties.

What MD would want to go thru 3 years of fellowship to make the same or less than primary care?  

You want an example of how bad Medicaid is?

In California a 99213 standard E&M code for Medicaid reimburses $10.12, for a comprehensive specialty care visit with an ENT, the reimbursement is $27.19.  What a joke!

 

 

 

[camoman1234]

On 3/20/2018 at 5:08 PM, Gordon, PA-C said:

Peds is struggling because the peds subspecialists in many cases make LESS than the peds primary care doctors do.

Take cardiology or heme/onc for example.  75% of those patients are on Medicaid.  That means you get a massive paycut compared to adult specialties.

What MD would want to go thru 3 years of fellowship to make the same or less than primary care?  

You want an example of how bad Medicaid is?

In California a 99213 standard E&M code for Medicaid reimburses $10.12, for a comprehensive specialty care visit with an ENT, the reimbursement is $27.19.  What a joke!

 

 

 

I get $13 for well child exams. :)

[lkth487]

With that said, Cardiology and Heme Onc are probably the most competitive of all the pedi subspecialities.  Cards makes more than pedi generalists but heme/onc makes less - and it's a BRUTAL fellowship to boot. 

But gotta love what you do!  I thought about it for a bit - I was between NICU, PICU and Heme/Onc at the end.  A 5 yo kid you diagnosed with leukemia, went through the hell of chemo and a BMT - then comes out the other end healthy?  And then getting a birthday card of him celebrating with cake being a normal kid?  No price on that.  There is nothing else in medicine that beats that.  Best memory of residency for sure.  And the single coolest thing in medicine was my interventional cards rotation where you're closing a lesion in a newborn and watching them improve real time.  Yea I chose to make less money for my life when I could have done an IM subspecialty and made 2x, or anesthesia and rolled in it, but I come home and I'm EXCITED to go back to work.  It's not like adults where you feel like you're just fighting against the tide.

 

[Boatswain2PA]

16 hours ago, lkth487 said:

It's not like adults where you feel like you're just fighting against the tide.

 

Or EM....where you're fighting against Darwinism.

[Joelseff]

We can't count on NP to help US out! That's crazy. We need to advocate for ourselves. NPs will say that they are "down" with us but don't be surprised if they take us "down!" happened at my place...

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